Purpose or Learning Objective: The grade is crucial in the prognosis, evaluation of metastatic risk, and management of soft tissue sarcomas (STS). Our study evaluated the role of quantitative dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) parameters and diffusion-weighted imaging (DWI) in differentiating the grade of STS.
We aimed to evaluate the effectiveness and safety of radioembolization with yttrium-90 (90Y) microspheres in cases with unresectable neuroendocrine tumor liver metastases (NETLMs).Thirty patients (mean age, 55 years) underwent resin-based 90Y radioembolization for unresectable NETLM at a single institution between April 2008 and June 2013. Post-treatment tumor response was assessed by cross-sectional imaging using the Response Evaluation Criteria in Solid Tumors (RECIST). Prognostic variables that affected survival were determined.The mean follow-up was 23.0±19.4 months and the median overall survival was 39 months (95% CI, 12.6-65.4 months), with one- and two-year survival rates of 71% and 45%, respectively. Imaging follow-up using RECIST at three-month intervals demonstrated partial response in 43%, complete remission in 3%, stable disease in 37%, and progressive disease in 17% of patients. Extent of tumor involvement was found to have a statistically significant influence on overall survival (P = 0.03). The existence of extrahepatic disease at the time of radioembolization, radiographic response, age, and primary neuroendocrine tumor site were not significant prognostic factors.The current study demonstrates the effectiveness and safety of radioembolization for the treatment of unresectable NETLMs. We identified that the extent of tumor involvement has a significant effect on overall survival. The use of imaging methods reflecting metabolic activity or cellularity such as scintigraphy or diffusion-weighted MRI would be more appropriate, for the response evaluation of liver metastases after radioembolization.
Background/aim: To describe the role of baseline gallium (Ga)-68 DOTATATE positron emission tomography (PET)/computed tomography (CT) in the prediction of the response to peptide receptor radionuclide therapy (PRRT) using lutetium (Lu)-177 DOTATATE. Materials and methods: Analysis was made of baseline Ga-68 DOTATATE PET/CT images of 29 patients (17 females and 12 males; mean age: 50.7 ± 14.6 years) with metastatic neuroendocrine tumors who received PRRT with Lu-177 DOTATATE. Maximum standardized uptake values (SUVmax) of reference lesions and their ratios to physiological uptake organs were calculated. The relationship between these values and the radiological response was analyzed. Results: Partial response was observed in 8 (28%) patients, stable disease in 18 (62%) patients, and progressive disease in 3 (10%) patients. Mean SUVmax of reference lesions was calculated as 23.8 ± 20.5 (min-max: 5.1-87.3). There was no significant correlation between radiological responses and SUVmax of reference lesions and their ratios to other organs. Conclusion: Baseline Ga-68 DOTATATE PET/CT helps to show somatostatin receptor expression status and disease stage in patients who are candidates for PRRT. However, SUVs do not have a role in the prediction of treatment response.
A 69-year-old female patient was admitted to our emergency service with painful oral ulcers and rectal bleeding. She has been used methotrexate (MTX) because of rheumatoid arthritis (RA). The patient has been used methotrexate every day for 10 days instead of a weekly treatment. Pancytopenia was seen in laboratory tests. Rectal bleeding associated with gastrointestinal mucosal erosion was attributed to MTX toxicity and MTX-induced thrombocytopenia. The direct cause of MTX intoxication in this case was accidental daily use instead of a weekly use. This case demonstrates the importance of communicating adequately with health professionals and emphasizes that MTX should be used weekly. It is essential to describe in detail how the medication can be used and what adverse effects may occur as the result of taking MTX.
Failure of these treatments led the physicians and the industry to investigate new techniques for better success rates to treat these large complex aneurysms.With the development of low-profile microcatheter-delivered self-expanding stents, intracranial parent artery reconstruction became feasible.Initially used technique was stent assisted coiling that resulted in better packing of the coils.With stenting, recurrence rates █ INTRODUCTION Endovascular aneurysm embolization with coils have been criticised for inability to achieve durable aneurysm exclusion when compared to surgical clipping.With coil embolization, this is valid especially for large and wide neck aneurysms that cannot be occluded completely during the procedure and at follow-up they usually show high rates of re-canalization (8,27). AIM:We evaluated the procedural outcomes of intracranial aneurysm treatment with the Silk device and its relation with operator experience.We also detailed some technical points we learned throughout our experience. MATERIAL and METHODS:One hundred and six consecutive patients with intracranial aneurysms treated using Silk (BaltExtrusion, Montmorency, France) stent between October 2010 and November 2013 were included.Patients were evaluated in terms of age, sex, aneurysm size, location, technical success, and adverse events.RESULTS: There were 106 patients (71 female) undergoing 116 procedures with a mean age of 49.8 (range: 3-78 years).Mean aneurysm size was 10.7±8.0 (range, 2-40 mm).Technical success of the procedures was 96.5%.Adverse event rate was 11.2%.Among adverse events, there were 4 adverse events without complications, 2 mild complications, 7 severe complications, 4 of which resulted with death.The adverse event rate was significantly higher during the first half of the operator's experience.The rate of adverse events seemed to stabilize after around 50 patients.Adverse events, regardless of the presence or absence of a clinical complication, were more frequent in aneurysms larger than 18.5 mm. CONCLUSION:Safety of flow-diverter (FD) placement for intracranial aneurysms increases with operator experience.Training programs in endovascular management of cerebrovascular diseases and relevant fellowship curricula must be adapted to include sufficient flow diverter experience.The learning curve needs to be kept in mind when studies comparing different FD devices or those comparing other treatments to FDS are planned.
To report the initial experience of cerebral aneurysm treatment with Tapered flow diverters (TFDs).Thirty patients with 34 aneurysms underwent cerebral aneurysm treatment with TFD (Silk, Balt, Montmorency, France) between March 2011 and March 2016. Procedural findings, complications, clinical and imaging follow-up were assessed retrospectively.The patients" mean age was 48±14.5 years (range, 16-74; 25 females). Aneurysms size ranged from 3 to 35 mm with an average diameter of 13.9±8.8 mm and a median diameter of 10.5 mm. Technical success rate was 96.6%. Technically, deployment of the device was similar to the non-tapered version and subjectively, it appeared to be easier in the paraophthalmic segment. Permanent morbidity and mortality rates secondary to the procedure were 0%. On clinical follow-up (29 patients, mean 9.3±9.1 months) there were no clinical untoward events. Imaging follow-up was at or after 6 months (20 patients, mean 12.3±10 months). Angiographic occlusion rate was 80%.TFD is safe to use and effective for the treatment of intracranial aneurysms in this series. The occlusion rate is higher with respect to the previous reports and experience using the non-tapered version. Maintenance of porosity at the transition zone may be the factor underlying the higher occlusion rate. TFD may be preferred especially for arterial segments aneurysms where there is considerable discrepancy in size between the distal and proximal parent artery.
To report patient and procedure-related factors affecting the angiographic and clinical outcome in patients treated with the Silk device.All patients with intracranial aneurysms in whom treatment was attempted with the Silk flow diverter by our neurovascular team between October 2010 and November 2013 were included consecutively. The data was analyzed by an independent stroke neurologist not involved in the treatment of the patients.A total of 96 patients (64 female) with ages range from 3 to 78 were included in this study. We found that 54 of the patients were asymptomatic and 42 of them symptomatic, while 21 had a prior history of subarachnoid hemorrhage (SAH). Mean aneurysm size was 10.2 mm (range 2 to 40 mm). 2 patients died due to consequences of SAH. 3 patients developed visual decline on the follow-up, 2 of these were procedure-related. Symptomatic thromboembolic events were noted in 7 cases. Patients with aneurysms smaller than 13 mm had significantly less complications and higher occlusion rates. The complication rate was significantly high in patients admitted with symptoms. Adjunctive coiling had no impact on outcome.Safety and efficacy of flow diversion in this series was closely related to aneurysm size and presenting symptoms. A size cut-off for safety and efficacy has not been reported before and will be useful not only for future studies but also for patient counseling in daily practice. The futility of adjunctive coiling in this series calls for reappraisal of the current recommendations for this specific device.
Dapson sentetik sulfonlar grubuna ait bir anilin turevidir. Etki mekanizmasi dikkate alindiginda dapsonun hem antibakteriyel hem anti-inflamatuvar etkisi oldugu gorulur. Dapson nadiren hemoglobin oksidasyonunu indukleyerek eritrosit icerisinde bulunan sitokrom b5 reduktaz enzim aktivitesini azaltir ve belirgin methemoglobinemiye yol acar. Bu yazida sekiz yildan bu yana diskoid lupus tanisi ile dapson kullanan 36 yasinda bir erkek hastada gelisen methemoglobinemi olgusu sunuldu.
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